Drug Summary

Nitroglycerin (Nitrostat®)

Pharmacologic properties:

Nitroglycerin is an organic nitrate which causes systemic vasodilation by entering vascular smooth muscle, converting to nitric oxide, and activating cGMP. This dose-dependent dilation acts primarily on the venous system, although it also produces direct coronary artery vasodilation as well. The overall result is a decrease in venous return which decreases the workload on the heart and thus, decreases myocardial oxygen demand. Nitroglycerin also improves blood flow to the myocardium and lowers systemic blood pressure.


  • Chest pain with suspected cardiac ischemia
  • Suspected acute myocardial infarct
  • Acute dyspnea with suspected pulmonary edema/congestive heart failure


  • Hypertension associated with acute stroke or severe brain injury
  • Systolic BP < 90 mmHg
  • Phosphodiesterase-5 inhibitor use within 24 hours (Viagra® or Levitra®) or 48 hours (Cialis®)


  • Use with caution in acute inferior wall MI or right ventricular infarct (ST elevation in V4R) - be prepared to administer 250 mL NS bolus if hypotension develops
  • Patients on chronic nitrate therapy may require larger doses of nitroglycerine during acute anginal episodes
  • Nitro tablets are inactivated by light, air and moisture and must be kept in amber glass containers with tight-fitting lids
  • Alcohol will accentuate vasodilating and hypotensive effects

Adverse Reactions:

  • Headache
  • Hypotension
  • Tachycardia
  • Dizziness
  • Flushing
  • Nausea and vomiting

Dosage and administration:

  • 0.4 mg spray or tablet sublingually, every 5 minutes as needed if no contraindication develops